Provider Demographics
NPI:1407944812
Name:MCKINNEY, CHAD EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:EDWARD
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 W SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4903
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:
Practice Address - Street 1:3880 W INA RD STE 132
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2356
Practice Address - Country:US
Practice Address - Phone:520-579-9641
Practice Address - Fax:520-579-9644
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5223T2127152W00000X
AZOPT-002330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2357711Medicaid
MC4100431Medicare ID - Type Unspecified
OH2357711Medicaid